Sterilization. Low-income women have special counseling needs
Contraceptive Technology Update 14(5): 74-77
1993
ISSN/ISBN: 0274-726X PMID: 12345151 Document Number: 333218
An increasing percentage of low income women are using sterilization as a method of contraception. 26% of low income women in 1982 used sterilization; 37% used it in 1988. This group of women has less access to services and information than women in other income brackets, who use sterilization less. A 16 page booklet, which is based on a study, conducted from 1985-1989 at three hospital clinics, of 1800 low income women, has been prepared by the Association for Voluntary Surgical Contraception (AVSC) for use by counselors. According to Joseph Feldman of Planned Parenthood of Central and Northern Arizona (PPCNA), low motivation to postpone pregnancy (due to concentration on the roles of wife and mother) and a sense of powerlessness over their lives are problems among poor women. Libby Antarsh of AVSC states the booklet has been designed to give women all the information necessary for an informed decision. Susan Philliber of the State University of New York at New Paltz, one of the investigators in the study, says the booklet removes one of the barriers to sterilization by alleviating the fears of physicians concerned about litigation. Barriers faced by low income women in undergoing sterilization, as revealed by the study, include 1) inadequate health care services and overburdened clinic staff; 2) less access to information about contraception, and less knowledge about using the health care system; and 3) little economic or psychological support for these, often, single parents. Culture effects support for the women and their ability to use the information provided. The number of women who actually follow through on being sterilized is double among those with the approval of their male partners. Counselors should include partners and discuss the influences of others who are pressuring the woman (friends, family, physicians). The woman should separate her feelings, but be aware of the consequences of the disapproval of others. Accurate information concerning negative results should be discussed. The study, in which women were interviewed before and after sterilization, showed that experiences after surgery corresponded to expectations before surgery. Since funding and bureaucracy postpone sterilization for poor women, a list of past bureaucratic problems will allow development of a plan that eliminates or deals with them in other ways. Under federal law, postpartum sterilization funded by public money must be delayed 30 days after signature of an informed consent form; if the baby arrives earlier, the operation may be denied. Waivers are available and counselors should be aware of this. Information about obtaining the booklet is given (cost, address).